Hitting the ground running

One thing I like about this whole graduate entry veterinary medicine program is that they expect that we have a lot of previous knowledge. One thing I dislike about this whole graduate entry veterinary medicine program is that they expect that we have a lot of previous knowledge.

For evidence of the above, I present this week’s case study (in one class, and, sadly, I have six). I mean, I’m supposed to answer these questions, and, well, I am used to trying to swallow lots of theory before I get to look at anything practical. So I like this kind of homework. It makes me feel all warm and fuzzy, like, maybe by the end of this LONG stint, I will be a doctor. On the other hand, I don’t even know what ‘tachypnoic’ means! I guess we all know one of my Saturday tasks.

History:

Two month-old Tb foal presented for coughing and exercise intolerance.

Clinical examination:

Foal bright, alert and standing and in good body condition. The foal was febrile and tachypnoic with a nostril flare and marked inspiratory and expiratory movement of the thoracic cage. Auscultation of the lungs revealed bilateral, generalised inspiratory and expiratory wheezes.

Questions (please take into consideration chapter 45):

What are some differentials for the lower airway abnormality?

Why is the foal tachypnoic? Why are the nostrils flared? Describe the mechanics involved with inhalation and exhalation in this case.

What would be contributing towards/creating the abnormal lung sounds (i.e., what changes are occurring in the lower airway)?

What diagnostics would be helpful in determining the cause of the lower airway abnormality as well as assisting in determining treatment?

hmmm…. the sad thing is, I understood every word in that post, except the Tb before foal, unless it is referring to tuberculosis. Do they do chest xrays on animals? Because that is what you would do if it were a human. STAT. Sounds like your mental capacities are being stretched and expanded!

Tuberculosis is TB, I think. The whole Tb thing is a horsey kind of thing. Apparently it means ‘thoroughbred,’ and one then is supposed to infer that the animal is quite physically active (and fit). Yes, they do chest x-rays on animals, but part of being a veterinarian is supposedly learning how to deal with these situations when you don’t have access to a nicely equipped hospital and/or lab. So I guess in this case we were supposed to know that a bronchial alveolar levage would be a great thing to do, and that there was a good chance that this silly horse has some infectious agent, and that the levage would help you determine that. Of course, I didn’t know any of that! 🙂

Bronchial alveolar lavage?? Isn’t that a little archaic? Why not treat the poor little beast with some broad spectrum antibiotics for the pneumonia it most assuredly has? I would think that x-raying a horse for pneumonia would be cost prohibitive, no? As for the bronchial alveolar lavage, are you culturing the expectorant? The results of a culture will take 2-3 days at least. Wouldn’t there be irreversible damage to lung tissue by then? Are you as worried about antibiotic resistance in animals as we are in humans? Do horses contract TB, what are your differential diagnosis? By the way, I can help you out with the definition of tachypnoic except it is spelled tachypneic in this part of the world! Thanks for the look into your life for the day, I’d enjoy accompanying you for a day or two!!!

Hey, you’re asking the wrong person! The BAL was to determine the exact nature of the pneumonia, although the case is suggestive of R. equii (how do you get italics?). Also, this treatment was suggested by the prof, who not only is one of the leading equine clinicians in Europe, but also claims to know a lot more about treating horses than I! She said that in an ideal world you’d do a BAL, but in the real world you’d have a little list of your favourite antibiotics, and give the horse something broad spectrum, hoping for the best. Yes, I think doing anything else (e.g., x-rays) would only be done on some super-duper racehorse, where cost isn’t an issue.
Frankly, I really dislike cardiovascular and respiratory stuff! Since this involved microbiology, it was sort of palatable.
(In my searches, I had come across that website. Does that mean that BALs are more common for horses?)